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Compliance FAQs

Frequently Asked Questions & Answers (FAQs) about the Eight Most Common Compliance Issues

For each of the issues below the PIC Compliance FAQs provides a brief summary of legal coverage and benefits rights under the parity statute.
You can use the answers we've given to each question to help prepare your request for coverage and/or your appeals for denials of treatment. Pick the categories or questions relevant to your distinct parity coverage and/or reimbursement issues and use only those legal analyses that provide the legal rationale that will assist you with your particular situation.

  • Refusal to pay for or provide coverage for specific types of MH/SUD treatment of levels of care
  • Application of parity (MHPAEA) to medical management
  • Discrimination in reimbursement practices
  • Application of parity (MHPAEA) to Medicaid managed care plans
  • Discrimination in any cost containment practices
  • Application of parity (MHPAEA) to psychiatric and addiction medications
  • Need for compliance with all aspects of parity (MHPAEA) if an insurance plan pays for one or more MH/SUD treatments
  • Requirement to use a national clinical standard when using more restrictive cost containment practices

Click to read a copy of PIC's Compliance FAQs.

These answers and supporting legal rationale were prepared by Patton Boggs, LLP, a leading health care law firm in Washington, DC.

If you have questions or concerns or wish to report about problem with MHPAEA compliance issues not addressed in the FAQs, please feel free to e-mail, or send us a note.

Additional FAQs

PIC proposes Frequently Asked Question (FAQ) on acute care only coverage limitation be posted on the DOL website.

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